title: Post-traumatic delayed onset pectoralis myospasm secondary to α-γ dysfunction.
abstract: A restrained motor vehicle accident victim suffered from delayed onset left pectoralis myospasms refractory to multiple treatments: behavioural, conservative, physical therapy, opiate, muscle relaxer and incomplete response to invasive pain management spinal blocks. After conduction of a literature review, several authors had noted the mechanism of α-γ loop dysfunction resulting in myospams, and also case studies which described painful postsurgical myospasms that were treated with neurectomy and/or botulinum toxin A with successful results. The patient in this case underwent an initial lidocaine injection to observe response to treatment, followed by two treatments with botulinum toxin A treatment with subsequent resolution of symptoms. Successful therapy and previous research supports that botulinum toxin A can be an effective treatment for myospasms secondary to trauma-induced α-γ dysfunction, as suggested by the cellular pathophysiology.
authors.affiliation: Madigan Army Medical Center, Tacoma, Washington, USA. dennis.barnett@amedd.army.mil
authors.forename: Dennis L
authors.initials: DL
authors.lastname: Barnett
authors.forename: Klinton
authors.initials: K
authors.lastname: McGhee
authors.forename: Paul
authors.initials: P
authors.lastname: Bungee
mesh_terms: D000063:Accidents, Traffic; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009119:Muscle Contraction; D063806:Myalgia / Q000188:drug therapy* / Q000209:etiology; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010369:Pectoralis Muscles / Q000293:injuries / Q000294:innervation*; D013035:Spasm / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A